Your eligibility to obtain the full $10,000 of your PIP coverage to compensate for a part of your medical bills depends on the diagnosis of an Emergency Medical Condition. According to the Florida PIP Statute §627.732, an “emergency medical condition” is defined as a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention would reasonably be expected to result in any of the following:

  1. Serious jeopardy to patient health
  2. Serious impairment of bodily function
  3. Serious dysfunction of any bodily organ or part

That is the only criteria that medical providers have to go by in determining if the extent of your injuries can classify as an EMC, so it leads to a lot of “grey area” when it comes to its guidelines. It is up to the medical doctor’s professional opinion whether or not their patient’s injuries following an accident fall under the statute’s definition of an EMC.

Another “grey area” in the PIP law is that there is no requirement for the doctor to write verbatim that an EMC is present. There are advantages and disadvantages to the vagueness. It allows for the attorney to prove your injuries are as severe enough based on the medical reports from the doctors even if it isn’t directly written out that there is an EMC; However, it also allows for the insurance company to easily deny the full coverage if the doctor doesn’t properly convey that the injuries constitute an emergency medical condition.

Further confusion occurs with the timeframe in which you must receive medical treatment. Florida law requires an injured person to receive medical treatment within 14 days of the incident in order to be eligible to receive full PIP coverage. But, there is no time limit for someone to be diagnosed with an EMC because X-Rays, MRIs, and other tests take longer to receive the results. It is always important to seek medical attention as soon as possible after an accident whether or not you can receive the full $10,000. If you wait a long time to get treated, not only will you miss out on using your PIP benefits, but it will also allow for the insurance company to assume your injuries are not as severe as you’re leading on.  Check out my blog on the topic of "No Fault" or PIP insurance here.

               Because of the perplexities of some Florida Laws, especially the PIP statute, we are there to avoid any confusion and make sure you are able to receive your full benefits and the compensation you deserve!